When I first met “Jody,” she had recently lost her job and, with it, her health insurance. She had started rationing her antidepressant medications, taking one pill every couple of days so that she wouldn’t run out. Unfortunately, her medication was not effective when taken this way and, with her depression uncontrolled, it was a struggle to get out of bed, let alone find new work.

Unlike “Mary” and “Jody,” when I first met “Dennis,” he did have insurance, though his coverage did not include the medications he needed to manage his diabetes effectively. Without these essential drugs, his blood sugar remained high and several months later he was facing amputation due to complications of a diabetic foot wound.

Each of these patients struggled to access the medical care they needed due to lack of comprehensive health insurance. Had “Mary” been able to enroll in health insurance 10 years ago, it is likely that her cancer would have been diagnosed much sooner, allowing for earlier and more effective treatment. Had “Jody” remained insured without a lapse in coverage, it is far more likely that she would have continued treatment to manage her depression, increasing her chances of finding a new job when she needed one. Had “Dennis” been enrolled in an insurance plan that covered his diabetes medications, his blood sugar would have almost certainly been better controlled and it is possible that his foot infection and the resulting amputation could have been avoided.

Almost all Americans rely on health insurance coverage to access high-quality health care. Lack of insurance is associated with delayed diagnoses, decreased preventative health care, inadequate treatment of chronic conditions, and increased mortality, not to mention significant medical debt. In contrast, enrollment in a health insurance plan has been associated with improved health outcomes.

In states that adopted Medicaid expansion following passage of the Affordable Care Act (including New Hampshire), residents are more likely to have a primary care doctor, have access to mental health and substance use disorder treatments, and report improvements in health and wellness when compared to peers in states that did not expand access to insurance. Medicaid expansion has even been linked to decreased rates of violent crime. Ultimately, our communities are healthier when our neighbors are too.

Without reauthorization by the state legislature this legislative session, Medicaid expansion in New Hampshire could expire on December 31, 2023. What would this mean for our state? It would mean that there would be an estimated 90,000 more Granite Staters (equivalent to roughly the entire population of Nashua) just like “Mary,” “Jody,” and “Dennis.” It would mean that more people with cancer would face delayed diagnoses. It would mean that more people with mental health concerns would go untreated. It would mean that more people with diabetes would suffer from the long-term complications of high blood sugars. It would also mean that our health care system, which is already overwhelmed and understaffed, would face even more pressure trying to care for patients who are sicker, waiting in the packed waiting rooms of hospitals that already don’t have any available beds.

How can our lawmakers help? Step one is to reauthorize Medicaid expansion to ensure that all Granite Staters have access to the health care that they need when they need it. Take it from a primary care doctor — our health care system can’t handle one more “what if.”